High standard uptake value on FDG-PET/CT of the primary lesion of hepatocellular carcinoma correlates with early recurrence after curative resection

Abstract Purpose Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is useful for detecting the presence of distant metastases in many types of cancer, including hepatocellular carcinoma (HCC). However, the clinical significance of the standard uptake value (SUV) in primary HCC lesions is unclear. Therefore, we investigated the relationship between the SUV, clinicopathological factors, and prognosis in HCC. Methods The retrospective analysis included 86 patients with HCC who underwent FDG-PET/CT prior to liver resection. The distribution of SUV was compared in three groups: no recurrence after surgery, recurrence within 2 years, and recurrence after 2 years. The optimal cut-off SUV were determined based on receiver operating characteristic curve analysis to detect the recurrence within 2 years. All patients were divided into two groups based on the cut-off: low and high SUV. Cox univariate and multivariate analyses were performed for disease-free survival. Results The SUV was significantly higher in patients with recurrence within 2 years. The optimal cut-off SUV was 5.0. The patients in the high SUV group had significantly higher des-γ-carboxy prothrombin, poorer differentiation, and larger tumor diameter than the low SUV group, and presented with pathologically positive intrahepatic metastases. Moreover, high SUV was a significant and independent prognostic factor. In a subgroup analysis, high SUV had a significantly lower 2-year disease-free survival rate than the low SUV group in tumors ≤ 3.5 cm. Conclusion High SUV (≥ 5) on FDG-PET/CT of the primary HCC lesion, especially tumors ≤ 3.5 cm, correlates with early recurrence after curative resection and is an independent prognostic factor.